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Choi NG, Marti CN, Choi BY. Mental Health Treatment Use, Perceived Treatment Need, and Reasons for Non-Use Among U.S. Adults with Serious Suicidal Thoughts During the COVID-19 Pandemic. Community Ment Health J 2024; 60:972-984. [PMID: 38372825 DOI: 10.1007/s10597-024-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Analyzing the 2021 National Survey on Drug Use and Health data with generalized linear models, we examined: (1) COVID pandemic-related and other correlates of mental health treatment use and unmet perceived treatment need among U.S. adults who experienced serious suicidal thoughts (N = 3,177); and (2) correlates of self-reported reasons for not receiving treatment. We found that 61% used any mental health treatment, and 48% of users and 37% of nonusers reported perceived treatment need. Significant correlates of treatment use were demographic factors, insurance, major depressive disorder, and illicit drug use disorder. Significant correlates of perceived treatment need were age 18-34, some college education, and major depressive episode. Perceived negative effect of the COVID pandemic on mental health was a significant factor for both treatment use and perceived need. The most frequent reasons for not getting treatment were the cost of treatment or lack of insurance and stigma-related concerns.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Philadelphia, USA
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Sadek J, Diaz-Piedra B, Saleh L, MacDonald L. A narrative review: suicide and suicidal behaviour in older adults. Front Psychiatry 2024; 15:1395462. [PMID: 38800059 PMCID: PMC11117711 DOI: 10.3389/fpsyt.2024.1395462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.
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Affiliation(s)
- Joseph Sadek
- Professor, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Leah Saleh
- Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Luke MacDonald
- MD Candidate, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Choi NG, Marti CN. Depression in older women who died by suicide: associations with other suicide contributors and suicide methods. J Women Aging 2024; 36:210-224. [PMID: 38090746 PMCID: PMC11062817 DOI: 10.1080/08952841.2023.2292164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/02/2023] [Indexed: 05/02/2024]
Abstract
Suicides among older women have received little research attention. In this study based on the 2017-2019 National Violent Death Reporting System data, we examined the prevalence of depression in older female suicide decedents (N = 3,061), associations between depression and other suicide precipitants, and the associations between suicide methods and depression. Descriptive statistics and generalized linear models (GLM) for a Poisson distribution with a log link were used to examine the research questions. Of the decedents, 15.0% had depressed mood without a reported diagnosis and 41.8% had a depression diagnosis. Nearly one-half of the decedents with reported depression were receiving mental health/substance use treatment at the time of injury. The likelihood of depression was lower among those who were age 85 and older compared to those were age 65-74, but higher among those who had anxiety disorder (IRR = 1.50, 95% CI = 1.33-1.69), history of suicidal ideation (IRR = 1.22, 95% CI = 1.10-1.35), history of suicide attempt (IRR = 1.27, 95% CI = 1.14-1.41), and bereavement problems (IRR = 1.45, 95% CI = 1.27-1.65). Those who had depression were less likely to have used firearms (IRR = 0.85, 95% CI = 0.75-0.97) but more likely to have used hanging/suffocation (IRR = 1.37, 95% CI = 1.13-1.67). The findings show that gun ownership was likely an important factor for firearm use. The high prevalence of depressed mood and/or depression diagnosis among older female suicide decedents at the time of their fatal injury underscores the importance of assessing depression and providing evidence-based depression treatment as an essential suicide prevention approach.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA
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Ki M, Lapierre S, Gim B, Hwang M, Kang M, Dargis L, Jung M, Koh EJ, Mishara B. A systematic review of psychosocial protective factors against suicide and suicidality among older adults. Int Psychogeriatr 2024; 36:346-370. [PMID: 38305360 DOI: 10.1017/s104161022300443x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. METHOD First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. RESULTS A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. CONCLUSION Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.
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Affiliation(s)
- Myung Ki
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Brain Korea 21 Four Research and Education Center, Korea University, Seoul, South Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montréal, Canada
| | - Boeun Gim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Minji Hwang
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Brain Korea 21 Four Research and Education Center, Korea University, Seoul, South Korea
| | - Minku Kang
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Luc Dargis
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montréal, Canada
| | - Myoungjee Jung
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Emily Jiali Koh
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
| | - Brian Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montréal, Canada
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Sharwood LN, Waller M, Draper B, Shand F. Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis. Int Psychogeriatr 2024; 36:405-414. [PMID: 37960921 DOI: 10.1017/s1041610223000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. DESIGN A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. SETTING Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. PARTICIPANTS Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. INTERVENTION CMH care within 14 days from index, versus not. MEASUREMENTS Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. RESULTS Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. CONCLUSIONS CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.
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Affiliation(s)
- Lisa N Sharwood
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Engineering, University of Technology Sydney, Sydney, NSW, Australia
- School of Population Health, University of NSW, Sydney
| | | | - Brian Draper
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, NSW, 2031, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales,Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
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Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. SSM Popul Health 2024; 25:101592. [PMID: 38283541 PMCID: PMC10821139 DOI: 10.1016/j.ssmph.2023.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Background Self-harm and suicide remain prevalent in later life. For younger adults, higher early-life cognitive ability appears to predict lower self-harm and suicide risk. Comparatively little is known about these associations among middle-aged and older adults. Methods This study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort (N = 53037), using hospital admission and mortality records to follow individuals from age 34 to 85. Multistate models examined the association between childhood cognitive ability and transitions between unaffected, self-harm, and then suicide or non-suicide death. Results After adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among both males (451 events; HR = 0.90, 95% CI [0.82, 0.99]) and females (516 events; HR = 0.89, 95% CI [0.81, 0.98]). Childhood cognitive ability was not significantly associated with suicide risk among those with (Male: 16 events, HR = 1.05, 95% CI [0.61, 1.80]; Female: 13 events, HR = 1.08, 95% CI [0.55, 2.15]) or without self-harm events (Male: 118 events, HR = 1.17, 95% CI [0.84, 1.63]; Female: 31 events, HR = 1.30, 95% CI [0.70, 2.41]). Limitations The study only includes self-harm events that result in a hospital admission and does not account for self-harm prior to follow-up. Conclusions This extends work on cognitive ability and mental health, demonstrating that these associations can span the life course and into middle and older age.
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Affiliation(s)
| | - Emily L. Ball
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | | | - Ian J. Deary
- Department of Psychology, The University of Edinburgh, UK
| | - Simon R. Cox
- Department of Psychology, The University of Edinburgh, UK
| | - G. David Batty
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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Weaver RH, Bolkan C, Coatsworth JD, Hill LG. Introduction to the Special Issue: Toward a Lifespan Prevention Science - A Focus on Middle and Late Adulthood. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:799-807. [PMID: 37249730 DOI: 10.1007/s11121-023-01555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
The interdisciplinary field of prevention science was founded on the premise of a lifespan developmental model. Prevention scientists have developed a strong set of tools and intervention technologies for understanding and potentially modifying risk and protective factors through early adulthood. However, there is a demographic imperative to apply prevention science principles to health issues in middle and late adulthood. The articles in this special issue utilize a variety of methods to investigate important scientific questions about how theories, methodologies, and interventions applied in the science of prevention can be usefully integrated into the study of health and wellness in middle and late adulthood. More specifically, contributions (1) highlight current empirical research that draws on lifespan developmental science to address the unique prevention and intervention needs in middle and late adulthood, (2) illustrate the opportunities and challenges of a lifespan approach to prevention science with special attention to middle and late adulthood, and (3) identify additional areas that prevention science can contribute to advancements in middle and late adulthood. These articles provide a glimpse into the challenges and opportunities at the intersection of prevention science and gerontology. As a field, we have much room to grow in leveraging innovative tools, approaches, and efforts to best support older adults' physical, mental, and social health, particularly for diverse and under-served populations.
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Affiliation(s)
- Raven H Weaver
- Department of Human Development, Washington State University, Pullman, WA, USA.
| | - Cory Bolkan
- Department of Human Development, Washington State University, Vancouver, WA, USA
| | | | - Laura G Hill
- Department of Human Development, Washington State University, Pullman, WA, USA
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Puig-Amores I, Cuadrado-Gordillo I, Martín-Mora-Parra G. Health Service Protection vis-à-vis the Detection of Psychosocial Risks of Suicide during the Years 2019-2021. Healthcare (Basel) 2023; 11:healthcare11101505. [PMID: 37239791 DOI: 10.3390/healthcare11101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023] Open
Abstract
Health services are especially relevant in suicide prevention and intervention, representing a favourable environment in which to implement specific strategies to detect and address suicidal behaviours. Indeed, a significant proportion of people who die by suicide (DBS) present at primary care and mental health services during the last year, month, or even days before committing suicide. The objective of this descriptive and cross-sectional study of all registered cases of death by suicide (N = 265) in Extremadura (Spain) was to determine which of those people who died by suicide had mental health problems (MHP) and what type of assistance they had requested. Diagnoses, previous suicide attempts, type of health service, and last visit before death were explored with univariate analyses and logistic regressions. The proportion of people without MHP was found to be high, and these people had hardly visited the health services at all in their last year. People with MHP, between the ages of 40 and 69, and with previous suicide attempts were more likely to have visited the mental health service in the three months prior to their death. It is, thus, necessary to provide health professionals with tools and training in the prevention of and approach to suicide. Efforts must be directed towards effectively assessing mental health and the risk of suicide since a large proportion of people who die by suicide may go unnoticed.
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Affiliation(s)
- Ismael Puig-Amores
- Department of Psychology and Anthropology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain
| | - Isabel Cuadrado-Gordillo
- Department of Psychology and Anthropology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain
| | - Guadalupe Martín-Mora-Parra
- Department of Psychology and Anthropology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain
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Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.10.23285747. [PMID: 36798203 PMCID: PMC9934796 DOI: 10.1101/2023.02.10.23285747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Self-harm and suicide remain prevalent in later life. For younger adults, work has highlighted an association between higher early-life cognitive ability and lower self-harm and suicide risk. Comparatively little is known about its association with self-harm and suicide among older adults. Furthermore, most work has measured cognitive ability in early adulthood, raising issues of potential confounding by emerging psychiatric conditions. The present study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort of older adults (N = 53037), using health data linkage to follow individuals from age 34 to 85. Self-harm events were extracted from hospital admissions and suicide deaths were extracted from national mortality records. Multistate models were used to model transitions between unaffected, self-harm, and then suicide or non-suicide death, and to examine the association between childhood cognitive ability and each transition. After adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among older females (N events = 516; HR = 0.90, 95% CI = [0.81, 0.99]). A similar, though non-significant, association was observed among older males (N events = 451; HR = 0.90, 95% CI = [0.82, 1.00]). Although suicide risk was higher among older adults experiencing self-harm, childhood cognitive ability was not significantly associated with suicide risk among either older adults experiencing no self-harm events (Male: N events = 118, HR = 1.17, 95% CI = [0.84, 1.63]; Female: N events = 31, HR = 1.30, 95% CI = [0.70, 2.41]) or those experiencing a self-harm event during follow-up (Male: N events = 16, HR = 1.05, 95% CI = [0.61, 1.80]; Female: N events = 13, HR = 1.08, 95% CI = [0.55, 2.14]). Higher suicide risk was significantly associated with covariates including higher adulthood deprivation and longer time in the self-harm state. These results extend work on cognitive ability and mental health, demonstrating that these associations can span across the life course and into older age.
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Affiliation(s)
- Matthew H Iveson
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | - Emily L Ball
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | | | - Ian J Deary
- Department of Psychology, The University of Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, The University of Edinburgh, UK
| | - G David Batty
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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Kim J, Gwak D, Kim S, Gang M. Identifying the suicidal ideation risk group among older adults in rural areas: Developing a predictive model using machine learning methods. J Adv Nurs 2023; 79:641-651. [PMID: 36534434 DOI: 10.1111/jan.15549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 10/10/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
AIMS The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods. DESIGN This study applied an exploratory, descriptive and cross-sectional design. METHODS The participants were older adults (N = 650) aged over 65 living in rural areas of South Korea. Self-report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0. RESULTS The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity. CONCLUSION The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas. IMPACT Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings. REPORTING METHOD The reporting of this study (Observational, cross-sectional study) conforms to the STROBE statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. IMPLICATION FOR THE PROFESSION AND/OR PATIENTS CARE Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide.
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Affiliation(s)
- Junglyun Kim
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA
| | - DongHyeon Gwak
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Seonhee Kim
- Nursing Department, Songwon University, Gwangju, South Korea
| | - Moonhee Gang
- College of Nursing, Chungnam National University, Daejeon, South Korea
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Jeong KH, Yoon JY, Lee S, Cho S, Woo HJ, Kim S. Changes in the Suicide Rate of Older Adults According to Gender, Age, and Region in South Korea from 2010 to 2017. Healthcare (Basel) 2022; 10:2333. [PMID: 36421657 PMCID: PMC9690192 DOI: 10.3390/healthcare10112333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND South Korea's suicide rates are the highest among Organization for Economic Co-operation and Development (OECD) countries, making it one of the most important societal issues in South Korea. METHODS the statistics on causes of death and resident registration central population (RRCP) provided by the National Statistical Office were used to calculate the suicide rate among older adults in Korea. We examined gender (male, female), age (young-old, old-old), and region (urban, rural) by conducting latent growth modeling to estimate changes in the overall older adult suicide rate and verify its relationship. RESULTS over a period of 8 years, the older adult suicide rate was 104.232 on average in 2010 and it decreased by approximately 10.317 every year, and the rate of decrease gradually slowed down. The initial value of the older adult suicide rate was found to be higher among males, the old-old group, and those living in rural regions. In the quadratic function change rate, only males and the old-old group were statistically significant. CONCLUSION in this study, the direction of and the rate of change in the older adult suicide rates and the relationship between gender, age, and region were examined. It is expected that this study will provide basic data to assist in establishing older adult suicide prevention policies, considering the gender, age, and region of the aging population.
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Affiliation(s)
- Kyu-Hyoung Jeong
- Department of Social Welfare, Semyung University, Jecheon 27136, Republic of Korea
| | - Ji-Yeon Yoon
- Institute for Life and Culture, Sogang University, Seoul 04100, Republic of Korea
| | - Seoyoon Lee
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul 03722, Republic of Korea
| | - Sunghwan Cho
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23223, USA
| | - Hyun-Jae Woo
- Health & Welfare Committee, Seoul Metropolitan Council, Seoul 04519, Republic of Korea
| | - Sunghee Kim
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul 03722, Republic of Korea
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Characterizing Suicide Ideation by Using Mental Disorder Features on Microblogs: A Machine Learning Perspective. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00958-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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14
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Chattun MR, Amdanee N, Zhang X, Yao Z. Suicidality in the geriatric population. Asian J Psychiatr 2022; 75:103213. [PMID: 35917739 DOI: 10.1016/j.ajp.2022.103213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.
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Affiliation(s)
- Mohammad Ridwan Chattun
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Medical School of Nanjing University, Nanjing Brain Hospital, 22 Hankou Road, Nanjing 210093, China.
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15
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Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services. Int Psychogeriatr 2022; 34:813-826. [PMID: 33336632 DOI: 10.1017/s1041610220003853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand. METHODS interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales. RESULTS A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36-181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51-5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26-4.03), at-risk alcohol use (2.38, 1.30-4.35), and bipolar disorder (2.18, 1.25-3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36-0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35-0.89). CONCLUSION Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.
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Sufrate-Sorzano T, Pérez J, Juárez-Vela R, Garrote-Cámara M, de Viñaspre RR, Molina-Luque F, Santolalla-Arnedo I. Umbrella review of nursing interventions NIC for the treatment and prevention of suicidal behavior. Int J Nurs Knowl 2022. [PMID: 35997164 DOI: 10.1111/2047-3095.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this umbrella review was to determine the most effective nursing interventions for the prevention and management of suicidal behavior. In order to do so, the review identifies interventions from the Nursing Interventions Classifications taxonomy with evidence to this end. METHODS A systematic search was conducted for systematic reviews included in the PubMed, CINAHL, Cochrane, Scopus, Web of Knowledge, and Joanna Briggs Institute databases between January 1, 2011 and May 1, 2020. FINDINGS The review is made up of 21 systematic reviews. In order to carefully analyze the interventions described, these were coded into categories, grouping the interventions into those based on psychological therapy, interventions related to pharmacotherapy, interventions related to the professional relationship between health professional and patient, and interventions aimed at the general public. CONCLUSIONS Nursing interventions for suicide risk management are prevalent in the scientific literature and are shown to be effective for patients with suicidal ideation or suicide attempts. Prevention and treatment of suicidal behavior require the provision of coping tools, behavioral interventions that directly address suicidal thoughts and behaviors, and support through therapeutic partnerships, among others. IMPLICATIONS FOR NURSING PRACTICE This paper synthesizes the most current evidence on the most effective Nursing Interventions Classifications interventions for the treatment and prevention of suicidal behavior. It provides nursing practitioners with a comprehensive review of the therapeutic interventions with the best evidence and is useful for the development of clinical guidelines and protocols, as well as for the development of health policies and plans.
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Affiliation(s)
- Teresa Sufrate-Sorzano
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, La Rioja, Spain
| | - Jesús Pérez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Raúl Juárez-Vela
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, La Rioja, Spain
| | - MaríaElena Garrote-Cámara
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain
| | - Regina Ruiz de Viñaspre
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain
| | - Fidel Molina-Luque
- Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain.,Group for the Study of Society, Health, Education and Culture (GESEC). University of Lleida, Lleida, Spain.,Research Institute in Social and Territorial Development (INDEST), University of Lleida, Lleida, Spain
| | - Iván Santolalla-Arnedo
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, La Rioja, Spain
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17
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Junuzovic M. Firearm suicides in Sweden. J Forensic Leg Med 2022; 91:102403. [DOI: 10.1016/j.jflm.2022.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
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18
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Cations M, Collier LR, Caughey G, Bartholomaeus J, Lang C, Crotty M, Harvey G, Wesselingh S, Corlis M, Inacio MC. Government-subsidised mental health services are underused in Australian residential aged care facilities. AUST HEALTH REV 2022; 46:432-441. [PMID: 35772928 DOI: 10.1071/ah22049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities.MethodsA retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services.ResultsThe use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services.ConclusionsLess than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Luke R Collier
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Gillian Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jonathan Bartholomaeus
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Steven Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Megan Corlis
- Aged Care and Research, Australian Nursing and Midwifery Foundation, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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19
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Barak Y, Fortune S, Hobbs L, Cheung G, Johari N, Zalsman G. Strategies to Prevent Elderly Suicide: A Delphi Consensus Study. Australas Psychiatry 2022; 30:298-302. [PMID: 34927470 DOI: 10.1177/10398562211064256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In the next decades, many countries will become 'ageing societies'. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide. METHODS A New Zealand (NZ) 'expert panel' has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults' suicide prevention. RESULTS A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for 'A suicide prevention strategy for the elderly…' to enhance the national all-ages suicide prevention strategy. CONCLUSION The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.
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Affiliation(s)
- Yoram Barak
- Department of Psychological Medicine, 2495University of Otago, Dunedin, New Zealand
| | - Sarah Fortune
- School of Population Health, 1415University of Auckland, Auckland, New Zealand
| | - Linda Hobbs
- Department of Psychological Medicine, 2495University of Otago, Dunedin, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, 1415University of Auckland, Auckland, New Zealand
| | - Nurrul Johari
- Department of Psychological Medicine, 202495University of Otago, Dunedin, New Zealand
| | - Gil Zalsman
- Sackler Faculty of Medicine, 113169Geha Mental Health Centre, Petakh-Tikva, Tel Aviv University, Tel Aviv; Department of Psychiatry, Columbia University, New York, USA
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20
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Sakashita T, Oyama H. Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison. Front Public Health 2022; 10:842193. [PMID: 35619820 PMCID: PMC9127334 DOI: 10.3389/fpubh.2022.842193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study aimed to examine the effect on suicide rates of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them. We also wished to consider any different effects by sex. A literature search used PubMed and PsycINFO to identify systematic reviews of interventions in this age group. From the reference lists of these articles, we identified controlled studies assessing the impact of a multilayered program on suicide incidence among older adults. We were particularly interested in initiatives linking different kinds of prevention interventions. We found three relevant systematic reviews, and from these, we identified nine eligible studies. These included seven non-randomized controlled studies from rural areas in Japan (average eligible population: 3,087, 59% women, average duration: 8 years). We also found two cohort studies. The first was from a semi-urban area in Padua, Italy (18,600 service users, 84% women, duration: 11 years). The second was from urban Hong Kong, with 351 participants (57% women) over a 2-year follow-up period. We used a narrative synthesis of these studies to identify five different multilayered programs with different forms of connections or linkages between layers. Two studies/programs (Italy and Hong Kong) involved selective and indicated prevention interventions. One study/program (Yuri, Japan) included universal and selective prevention interventions, and the final six studies (two programs in northern Japan) involved linkages between all three layers. We also found that these linkages could be either formal or informal. Formal linkages were professional referrals between levels. Informal linkages included advice from professionals and self-referrals. Several of the studies noted that during the program, the service users developed relationships with services or providers, which may have facilitated movements between levels. All five programs were associated with reduced suicide incidence among women in the target groups or communities. Two programs were also associated with a reduction among men. The study authors speculated that women were more likely to accept services than men, and that the care provided in some studies did less to address issues that are more likely to affect men, such as suicidal impulsivity. We therefore suggest that it is important to build relationships between levels, especially between selective and indicated prevention interventions, but that these can be both formal and informal. Additionally, to reach older men, it may be important to create systematic methods to involve mental health professionals in the indicated prevention intervention. Universal interventions, especially in conjunction with systematically linked indicated and selective interventions, can help to disseminate the benefits across the community.
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Affiliation(s)
- Tomoe Sakashita
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | - Hirofumi Oyama
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
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21
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Spottswood M, Lim CT, Davydow D, Huang H. Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review. Front Med (Lausanne) 2022; 9:892205. [PMID: 35712115 PMCID: PMC9196265 DOI: 10.3389/fmed.2022.892205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review. Methods A narrative review was performed. Observations Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed. Conclusions and Relevance The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
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Affiliation(s)
- Margaret Spottswood
- Department of Psychiatry, University of Vermont Medical Center, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Community Health Centers of Burlington, Burlington, VT, United States
| | - Christopher T. Lim
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Dimitry Davydow
- Executive Leadership, Comprehensive Life Resources, Tacoma, WA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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22
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Seneviratne VL, Ranaweera S, Atkins M. Elder suicides: A reminder from the forgotten generation ……. Asian J Psychiatr 2022; 71:103028. [PMID: 35272255 DOI: 10.1016/j.ajp.2022.103028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
Abstract
Elder suicide is a significant public health issue in many countries. This reflects the complex underlying psychosocial, mental and physical health issues that older adults face. Increased life expectancy in developing countries has resulted in a gradual transition to an ageing population. Furthermore, in countries such as Sri Lanka, the transition occurs at a lower per capita income than in developed countries. This will negatively impact the availability of resources and service delivery to at-risk individuals. Thus, addressing elder suicide and concerns of elders are timely issues. This paper looks at the underlying risk factors associated with elder suicide and strategies that can be implemented in preventing elder suicide in the South Asian context, with reference to Sri Lanka.
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Affiliation(s)
- V Lakmi Seneviratne
- Victorian Institute of Forensic Mental Health, Yarra Bend Road, Fairfield, VIC 3078, Australia.
| | - Sajeeva Ranaweera
- Expert Committee on Suicide Prevention, Sri Lanka Medical Association, 6 Wijerama Mawatha, Colombo 7, Sri Lanka.
| | - Martin Atkins
- Gold Coast Mental Health Service, 1, Hospital Blvd, Southport, QLD 4215, Australia.
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23
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Gramaglia C, Martelli M, Scotti L, Bestagini L, Gambaro E, Romero M, Zeppegno P. Attempted Suicide in the Older Adults: A Case Series From the Psychiatry Ward of the University Hospital Maggiore Della Carità, Novara, Italy. Front Public Health 2022; 9:732284. [PMID: 35047468 PMCID: PMC8762240 DOI: 10.3389/fpubh.2021.732284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/01/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction: As suicide rates increase with age, it is mandatory to carefully assess old age suicidal behaviors. Our aim was to describe the main socio-demographic and clinical features of a sample of suicide attempters aged 65 years and older, and to assess differences within the sample (men vs. women; patients with vs. without a previous history of suicide attempt; patients with vs. without a previous psychiatric history). Methods: Retrospective study conducted at the Maggiore della Carità University Hospital, Novara, Italy. Results: A higher percentage of female patients in our sample were treated by or referred to mental health services, while a greater percentage of male patients required a prolonged clinical observation in the Emergency Room (ER) or in non-psychiatric wards before psychiatric admission. The percentage of patients without previous psychiatric history taking anxiolytic and sedative medications was 25%. Conclusion: It is likely that different clusters and types of suicide attempters exist. Women in our sample appeared more proactive in asking for help, and more likely to be already treated by or referred to a psychiatric service, suggesting the need to facilitate the access to psychiatric services for the male population aged 65 years and older, or to offer support and care for the non-psychiatric reasons (comorbidities, pain, and loss of autonomy) possibly underlying suicidal behavior in this specific group. The use of medications deserves more attention considering the possible critical diagnostic issues in this age group.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Maria Martelli
- Institute of Psychiatry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Lucia Bestagini
- Institute of Psychiatry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Romero
- Institute of Psychiatry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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24
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Riblet NB, Kenneally L, Stevens S, Watts BV, Gui J, Forehand J, Cornelius S, Rousseau GS, Schwartz JC, Shiner B. A virtual, pilot randomized trial of a brief intervention to prevent suicide in an integrated healthcare setting. Gen Hosp Psychiatry 2022; 75:68-74. [PMID: 35202942 PMCID: PMC8955571 DOI: 10.1016/j.genhosppsych.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients who die by suicide are often seen in primary care settings in the weeks leading to their death. There has been little study of brief interventions to prevent suicide in these settings. METHOD We conducted a virtual, pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients who presented to a primary care mental health walk-in clinic for a new mental health intake appointment and were at risk for suicide. Our primary aim was to assess feasibility. We measured our ability to recruit 20 patients. We measured the proportion of enrolled patients who completed all study assessments. We assessed adherence among patients assigned to VA BIC. RESULTS Twenty patients were enrolled and 95% (N = 19) completed all study assessments. Among the 10 patients assigned to VA BIC, 90% (N = 9) of patients completed all required intervention visits, and 100% (N = 10) completed ≥70% of the required interventions visits. CONCLUSION It is feasible to conduct a virtual trial of VA BIC in an integrated care setting. Future research should clarify the role of VA BIC as a suicide prevention strategy in integrated care settings using an adequately powered design. CLINICAL TRIAL REGISTRATION NCT04054947.
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Affiliation(s)
- Natalie B Riblet
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America.
| | - Lauren Kenneally
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Susan Stevens
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Bradley V Watts
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America; Veterans Rural Health Resource Center, White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Jiang Gui
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Biomedical Data Science, Dartmouth Institute, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Jenna Forehand
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Sarah Cornelius
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Glenna S Rousseau
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Jonathan C Schwartz
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Brian Shiner
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America; National Center for PTSD, Mental Health Service, Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
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Laflamme L, Vaez M, Lundin K, Sengoelge M. Prevention of suicidal behavior in older people: A systematic review of reviews. PLoS One 2022; 17:e0262889. [PMID: 35077476 PMCID: PMC8789110 DOI: 10.1371/journal.pone.0262889] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/09/2022] [Indexed: 01/08/2023] Open
Abstract
Older people have the highest rates of suicide, yet the evidence base on effective suicide preventions in late-life is limited. This systematic review of reviews aims to synthesize data from existing reviews on the prevention and/or reduction of suicide behavior in late-life and evidence for effectiveness of interventions. A systematic database search was conducted in eight electronic databases from inception to 4/2020 for reviews targeting interventions among adults ≥ 60 to prevent and/or reduce suicide, suicide attempt, self-harm and suicidal ideation. Four high quality reviews were included and interventions categorized as pharmacological (antidepressant use: 239 RCTs, seven observational studies) and behavioral (physical activity: three observational studies, and multifaceted primary-care-based collaborative care for depression screening and management: four RCTs). The 2009 antidepressant use review found significant risk reduction for suicide attempt/self-harm (OR = 0.06, 95% CI 0.01-0.58) and suicide ideation (OR = 0.39, 95% CI 0.18-0.78) versus placebo. The 2015 review found an increased risk of attempts with antidepressants versus no treatment (RR = 1.18, 95% CI 1.10-1.27) and no statistically significant change in suicides versus no treatment (RR = 1.06, 95% CI 0.68-1.66) or ideation versus placebo (OR = 0.52, 95% CI 0.14-1.94). Protective effects were found for physical activity on ideation in 2 out of 3 studies when comparing active versus inactive older people. Collaborative care demonstrated significantly less attempts/ideation (OR = 0.80, 95% CI 0.68-0.94) in intervention group versus usual care. The results of this review of reviews find the evidence inconclusive towards use of antidepressants for the prevention of suicidal behavior in older people, thus monitoring is required prior to start, dosage change or cessation of antidepressants. Evidence to date supports physical activity and collaborative management for reduction of suicide ideation, but additional trials are required for a meta-analysis. To build on these findings, continued high-quality research is warranted to evaluate the effectiveness of interventions in late life.
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Affiliation(s)
- Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
| | - Karima Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mathilde Sengoelge
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Chrzanowska A, Man N, Darke S, Degenhardt L, Farrell M, Moran L, Peacock A. Unintentional and intentional drug poisoning deaths, Australia, 2012-2016: Drug pattern profile and demographic characteristics. Drug Alcohol Depend 2021; 229:109112. [PMID: 34628104 DOI: 10.1016/j.drugalcdep.2021.109112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying differences in unintentional versus intentional drug poisoning deaths can inform targeted prevention. This study aimed to: compare unintentional versus intentional drug poisoning deaths by drug involvement, age and sex; describe patterns of drug involvement by intent; and describe common drug patterns by age and sex. METHODS Cases comprised deaths among Australians aged ≥15 where drug poisoning was the underlying cause (Cause of Death Unit Record File 2012-2016). Sex, age, and drug involvement were analysed by intent using logistic regression. RESULTS Of 7994 deaths, 71% were unintentional and 24% intentional. Compared with unintentional deaths, intentional deaths were more likely among females (OR 1.31 [95% CI 1.16-1.48]) and those aged 55+ (1.50 [1.25-1.81] for 55-64 years; 3.79 [3.07-4.66] for 65+ years, compared to 35-44 years), and were more likely to involve hypnosedatives (2.11 [1.87-2.39]), other psychotropic medicines (1.58 [1.39-1.78]), non-opioid analgesics and anaesthetics (1.48 [1.25-1.73]). Common unintentional profiles comprised: opioids (excluding heroin); heroin; alcohol; opioids with hypnosedatives; opioids with hypnosedatives and other psychotropic medicines; stimulants; other psychotropic medicines; and opioids with other psychotropic medicines. Unintentional deaths involving heroin or stimulants only had a greater proportion of males (79.0% and 83.4%, respectively) and younger individuals aged 15-34 (30.3% and 39.5%, respectively). Common intentional profiles comprised: hypnosedatives; other psychotropic medicines; opioids (excluding heroin); hypnosedatives with other psychotropic medicines; opioids with hypnosedatives; and opioids with hypnosedatives and other psychotropic medicines. CONCLUSION The demographic and drug involvement profile of intentional and unintentional deaths were distinct, suggesting different approaches to prevention are necessary.
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Affiliation(s)
- Agata Chrzanowska
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Nicola Man
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Lauren Moran
- Australian Bureau of Statistics, Belconnen, ACT, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychology, University of Tasmania, Hobart, Australia
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Hernandez SC, Overholser JC, Philips KL, Lavacot J, Stockmeier CA. Suicide among older adults: Interactions among key risk factors. Int J Psychiatry Med 2021; 56:408-421. [PMID: 33322985 DOI: 10.1177/0091217420982387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The present study aimed to understand how key risk factors of older adult suicide interact to ultimately lead to death by suicide using data collected post-mortem. METHOD A psychological autopsy was used to gather detailed information about psychiatric diagnosis, medical problems, social isolation, and negative attitudes expressed by the individual during the six months prior to their death. Interviews with next-of-kin, medical and psychiatric records, and the Cumulative Illness Rating Scale for Geriatrics were used. Subjects included 32 older adults who died by suicide and 45 older adults who died by natural causes. RESULTS Hopelessness, depression, and negative health attitudes were strongly correlated with suicide. Older age was associated with social isolation, suggesting an indirect relationship with suicide via hopelessness, depression, and negative health attitudes. Physical illness did not increase risk. Multivariate analyses suggested that hopelessness fully mediated the effects of social isolation, negative health attitudes, and depression on suicide. CONCLUSIONS Psychological factors played the largest role in suicide deaths compared to social isolation and physical illness. Suicide interventions aimed at older adults should ensure hopelessness, depression, and negative health attitudes are primary targets.
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Affiliation(s)
- Silvia C Hernandez
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - James C Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Kristie L Philips
- Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - James Lavacot
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Craig A Stockmeier
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MI, USA
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Hedna K, Montuori C, Forte A, Pompili M, Waern M. Use of antidepressants and risk of repeat self-harm in older adults 75+ with nonfatal self-harm: A 1-year prospective national study. Pharmacoepidemiol Drug Saf 2021; 31:206-213. [PMID: 34687250 DOI: 10.1002/pds.5375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess exposure to antidepressants (AD) before and after nonfatal self-harm (SH) in older adults and to examine 1-year rates and risk factors for subsequent SH. METHODS Longitudinal national register-based retrospective cohort study of Swedish residents aged 75+ (N = 2775) with treatment at hospital or specialist outpatient clinic in connection with SH between January 1, 2006, and December 31, 2013. The cohort was followed for 1 year after the index episode. Exposure to AD was assessed at index and at subsequent SH. Cox regression analysis was used to assess factors associated with 1-year repeat SH. RESULTS At the index episode, 51% were prevalent AD users; 23% started AD during the following year. Overall 12% of prevalent AD users, 8% of AD nonusers, and 6% of AD new users repeated SH or died by suicide. About two-thirds of these subsequent behaviors occurred within 3 months after the index episode. Men had increased risk of subsequent SH (Hazard ratio [HR] 1.38, 95% CI: 1.09-1.74); older age (>85 years) was associated with a lower risk (HR 0.72, CI 95% 0.55-0.93). Users of AD did not have an increased risk of repeat SH. CONCLUSIONS Half of older adults who self-harmed were prevalent AD users and a further one fourth started an AD within 1 year after the index SH. Antidepressant use was not associated with increased risk of subsequent SH in this high-risk cohort of older adults.
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Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden.,Statistikkonsulterna AB, Gothenburg, Sweden
| | - Chiara Montuori
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alberto Forte
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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Holmstrand C, Rahm Hallberg I, Saks K, Leino-Kilpi H, Renom Guiteras A, Verbeek H, Zabalegui A, Sutcliffe C, Lethin C. Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries. Aging Ment Health 2021; 25:1730-1739. [PMID: 32223443 DOI: 10.1080/13607863.2020.1745143] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the occurrence of suicidal ideation and associated factors in older persons with dementia living at home in eight European countries, and its association with quality of life. Furthermore, changes in suicidal ideation over time were investigated. METHODS This cohort study (n = 1,223) was part of the European "RightTimePlaceCare" project conducted in 2010-2013. Participating countries were Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the United Kingdom. Baseline and follow-up data were analysed using bivariate and multivariate logistic regression. RESULTS The occurrence of suicidal ideation in the participating countries varied between 6% and 24%. Factors significantly (p < 0.0018) associated with suicidal ideation using bivariate analysis were: nationality, depressive symptoms, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, night-time behaviour disturbances, anxiolytics and anti-dementia medication. In the multivariate regression analysis, country of origin, moderate stage of the dementia, depressive and delusional symptoms, and anti-dementia medication were significantly associated with suicidal ideation (p < 0.05). Over time, suicidal ideation decreased from severe to mild or became absent in 54% of the persons with dementia. CONCLUSION It is essential that professionals identify older persons with dementia and suicidal ideation and depressive and other psychological symptoms in order to give them appropriate treatment and provide relief for their informal caregivers. We emphasize the importance of identifying suicidal ideation, irrespective of depressive symptoms, and specifically of paying attention to persons with moderate dementia. Living with the informal caregiver seems to be associated with staying stable without suicidal ideation.
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Affiliation(s)
- Cecilia Holmstrand
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | | | - Kai Saks
- Faculty of Medicine, Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Helena Leino-Kilpi
- Department of Nursing Science and Turku University Hospital, University of Turku, Turku, Finland
| | - Anna Renom Guiteras
- Faculty of Health, Department of Nursing Science, University of Witten/Herdecke, Witten, Germany.,Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | | | - Caroline Sutcliffe
- Personal Social Services Research Unit, Faculty of Biology, Medicine and Health, Division of Population Health, University of Manchester, Manchester, United Kingdom
| | - Connie Lethin
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden.,Faculty of Medicine, Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Lund/Malmö, Sweden
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Oh HJ, Gang M, Kim MS. Development and Effect of a Salutogenic Program for Rural Elderly Women on Depression and Suicidal Ideation. Issues Ment Health Nurs 2021; 42:855-861. [PMID: 33320727 DOI: 10.1080/01612840.2020.1852458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to develop and evaluate the effects of a Salutogenic program on sense of coherence, depression, and suicidal ideation among rural older adults. Quasi-experimental, nonequivalent control group pretest-posttest design was used. Participants were female, aged 65 years and older from G and O province, South Korea. The experimental group (n = 22) received a 12-session Salutogenic program for 6 weeks, twice a week. The control group (n = 19) was put on a waiting list to receive the intervention after completing the study. Collected data were analyzed using descriptive statistics, a χ2 test, independent t-test, and repeated measure ANOVA with SPSS WIN 26.0. There were significant differences in sense of coherence (F = 19.34, p < .001), depression (F = 12.93, p < .001), and suicidal ideation (F = 4.40, p = .027) over time pretest, posttest, and follow-up test after intervention between two groups. The study discussed the effect of Salutogenic program on sense of coherence, depression, and suicidal ideation, and considered its benefits in suicide prevention for elderly women. The Salutogenic program can be recommended as useful strategies to enhance sense of coherence and to reduce depression and suicidal ideation of elderly women in community.
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Affiliation(s)
- Hyun-Joo Oh
- Nursing Department, Daejeon Institute of Science and Technology, Daejeon, South Korea
| | - Moonhee Gang
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Myung-Sook Kim
- Department of Nursing Science, Howon University, Gunsan, South Korea
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Holm AL, Salemonsen E, Severinsson E. Suicide prevention strategies for older persons-An integrative review of empirical and theoretical papers. Nurs Open 2021; 8:2175-2193. [PMID: 33619899 PMCID: PMC8363358 DOI: 10.1002/nop2.789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Accepted: 01/31/2021] [Indexed: 12/16/2022] Open
Abstract
AIM To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? DESIGN Integrative review. DATA SOURCES Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. REVIEW METHODS An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. RESULTS Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults' physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.
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Affiliation(s)
- Anne Lise Holm
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Elin Salemonsen
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Elisabeth Severinsson
- Nursing and Healthcare Research GroupDepartment of ResearchStavanger University HospitalStavangerNorway
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Fagerström C, Welmer AK, Elmståhl S, Tuvesson H. Life weariness, suicidal thoughts and mortality: a sixteen-year longitudinal study among men and women older than 60 years. BMC Public Health 2021; 21:1359. [PMID: 34243751 PMCID: PMC8268207 DOI: 10.1186/s12889-021-11329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Suicide in old age is a significant contributor to mortality. However, the extent to which life weariness and suicidal thoughts impact on mortality in a long-term perspective is unknown. The aim of this study was to investigate the effect of life weariness and suicidal thoughts on long-term survival (16 years) in an older Swedish population, controlling for demographic and social network factors and depression. A further aim was to investigate differences in sex and age interactions in relation to mortality among individuals with and without life weariness and suicidal thoughts. Methods A longitudinal cohort study on a national, representative sample of individuals aged 60+ years was conducted within the Swedish National Study of Aging and Care study. The sample included 7213 individuals, who provided information about life weariness and suicidal thoughts through an item derived from the Montgomery-Åsberg Depression Rating Scale. Data were analysed with multivariate Cox proportional hazards models, adjusted for potential confounders. Results At baseline, 12.5% of the participants (14.6% of females and 9.5% of males) reported life weariness and suicidal thoughts. During the 16-year follow-up, a mean survival time was 11.5 years (standard deviation (SD) 5.6), and 3804 individuals died (59.5% females and 40.5% males). Individuals with life weariness and suicidal thoughts had half the survival rate compared with those without such thoughts (24.5% vs. 50.6%), with a mean survival time of 8.4 years (SD 5.7) versus 12.0 years (SD 5.4). The multi-adjusted hazard ratio of mortality for those reporting life weariness and suicidal thoughts was 1.44 (95% confidence interval, 1.30–1.59), with the population attributable risk at 11.1%. In the models, being male or female 80+ years showed the highest multi-adjusted hazard ratio of long-term mortality (ref. female 60–69 years). Conclusions The findings suggested that life weariness and suicidal thoughts were risk factors for long-term mortality, when controlled for sex and age interactions that were found to strongly predict long-term mortality. These findings have practical implications in prevention of mortality, emphasising the importance of screening, identifying, and intercepting older men and women with signs of life weariness and suicidal thoughts. Trial registration Not applicable.
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Affiliation(s)
- Cecilia Fagerström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Anna-Karin Welmer
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
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Park E, Lee HY. Urban and rural differences in suicidal ideation and associated factors among older Koreans: Results from the Korean National Survey 2012–2013. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01962-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clapperton A, Dwyer J, Millar C, Tolhurst P, Berecki-Gisolf J. Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia. PLoS One 2021; 16:e0252682. [PMID: 34081748 PMCID: PMC8174715 DOI: 10.1371/journal.pone.0252682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022] Open
Abstract
Aims The aims of this study were to examine the prevalence of hospital contact in the year prior to suicide in Victoria, Australia, and to compare characteristics among those who did and did not have contact in the year prior to suicide. Methods The study was a data linkage cohort study of 4348 Victorians who died by suicide over the period 2011–2017. Data from the Victorian Suicide Register (VSR) was linked with hospital separations and Emergency Department (ED) presentations datasets by the Centre for Victorian Data Linkages (CVDL). The main outcomes were: (1) hospital contact for any reason, (2) hospital contact for mental-health-related reasons, and (3) hospital contact for intentional self-harm. Unadjusted and adjusted odds ratios were calculated as the measures of association. Results In the year prior to suicide, half of the decedents (50.0%) had hospital contact for any reason (n = 2172), 28.6% had mental-health-related hospital contact (n = 1244) and 9.9% had hospital contact for intentional self-harm (n = 432). In the year prior to suicide, when compared with males aged 25–49 years (the reference group):males aged 75+ years and females of all ages were significantly more likely to have hospital contact for any reason females aged 10–24 years and 25–49 years were significantly more likely to have mental-health-related hospital contact females aged 10–24 years and 25–49 years had 3.5 times and 2.4 times the odds of having hospital contact for intentional self-harm.
Conclusions The comparatively high proportion of female decedents with mental-health related hospital contact in the year prior to suicide suggests improving the quality of care for those seeking help is an essential prevention initiative; this could be explored through programs such as the assertive outreach trials currently being implemented in Victoria and elsewhere in Australia. However, the sizeable proportion of males who do not have contact in the year prior to suicide was a consistent finding and represents a challenge for suicide prevention. Programs to identify males at risk in the community and engage them in the health care system are essential. In addition, promising universal and selective interventions to reduce suicide in the cohort who do not have hospital contact, include restricting access to lethal means and other public health interventions are also needed.
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Affiliation(s)
- Angela Clapperton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Monash University Accident Research Centre, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Melbourne, Victoria, Australia
| | - Ciara Millar
- Coroners Prevention Unit, Coroners Court of Victoria, Melbourne, Victoria, Australia
| | - Penny Tolhurst
- Mental Health and Drugs Branch, Victorian Department of Health, Melbourne, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Melbourne, Victoria, Australia
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Tampi RR, Joshi P, Bhattacharya G, Gupta S. Evaluation and treatment of older-age bipolar disorder: a narrative review. Drugs Context 2021; 10:dic-2021-1-8. [PMID: 34113387 PMCID: PMC8166731 DOI: 10.7573/dic.2021-1-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This narrative review aims to synthesize information from the literature regarding older-age bipolar disorder (OABD) in order to provide up-to-date information on this important illness. Methods We searched Ovid (Medline, Embase and PsychInfo) on October 1, 2020, using the keywords “bipolar disorder”, “older adults” and “elderly” to identify relevant articles on OABD. Additionally, the bibliography of identified articles was reviewed for pertinent studies. Discussions OABD is a term that is used to describe bipolar disorder (BD) occurring amongst individuals ≥50 years of age. Evidence indicates that OABD accounts for a quarter of all cases of BD. When compared to individuals with early-onset BD, individuals with OABD have a greater association with cerebrovascular disease and other neurological disorders, less family history of mood disorders, and utilize almost four times the total amount of mental health services. In addition, they are four times more likely to have psychiatric hospitalizations when compared to age-matched controls. Despite a dearth of controlled studies on the use of pharmacotherapy amongst individuals with OABD, available evidence from mixed-age studies indicates the efficacy of commonly used medications in individuals with early-onset BD. Additionally, psychosocial treatments have been found to be effective as adjunctive management strategies amongst individuals with OABD. Furthermore, electroconvulsive therapy may be effective in the treatment of refractory cases of OABD. Conclusions There is a great need for an improved understanding of the phenomenology and neurobiology of OABD. Additionally, research into effective treatments for this serious psychiatric disorder will mitigate the suffering of individuals with OABD.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Pallavi Joshi
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Gargi Bhattacharya
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Sheila Gupta
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, Buffalo NY, USA
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Abstract
Objectives: Hope/hopelessness is an important determinant of health and death, and is a modifiable risk factor for older adults. The present review aimed to evaluate the effectiveness of interventions on hope among older populations. Methods: PsychINFO and PubMed were systematically searched. Publications reporting on interventions delivered to older adults that included quantitative data on hope/hopelessness were systematically reviewed. Results: Thirty-six studies were included, most with hope/hopelessness as a secondary outcome. Interventions based on CBT alone or combined with antidepressants significantly decreased hopelessness in depressed older adults. Psychological interventions based on life review effectively improved hope/hopelessness in a range of samples, including depressed, bereaving, or medically ill older adults. Little to no support was found for exercise programs for healthy older adults, educational interventions for medically ill individuals, or Dignity Therapy for palliative care patients. Conclusions: Hope/hopelessness in older adults can be improved using psychological interventions based on CBT and life review. Controlled trials with hope/hopelessness as a primary objective are needed to more clearly demonstrate effectiveness. Clinical implications: Cognitive-behavioral interventions can improve hopelessness in depressed older adults. Life-review based interventions can positively impact hope in a range of older populations. Dignity Therapy, physical exercise, and educational programs may not effectively improve hope/hopelessness in older adults.
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Affiliation(s)
- Silvia C Hernandez
- Department of Psychological Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - James C Overholser
- Department of Psychological Sciences, Case Western Reserve University , Cleveland, Ohio, USA
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Armstrong MJ, Sullivan JL, Amodeo K, Lunde A, Tsuang DW, Reger MA, Conwell Y, Ritter A, Bang J, Onyike CU, Mari Z, Corsentino P, Taylor A. Suicide and Lewy body dementia: Report of a Lewy body dementia association working group. Int J Geriatr Psychiatry 2021; 36:373-382. [PMID: 33169435 DOI: 10.1002/gps.5462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Public Health, Boston, Massachusetts, USA
| | - Katherine Amodeo
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Angela Lunde
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Debby W Tsuang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Mark A Reger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Jee Bang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.,Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
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Attachment anxiety, depression, and perceived social support: a moderated mediation model of suicide ideation among the elderly. Int Psychogeriatr 2021; 33:169-178. [PMID: 32375910 DOI: 10.1017/s104161022000054x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Issues concerning the association among attachment anxiety, depression and suicidal ideation among the elderly have rarely been explored. The present study investigated the relationship among attachment anxiety, depression and perceived support concerning suicidal ideation among older people. DESIGN Cross-sectional study. SETTING Tertiary care settings. PARTICIPANTS The authors recruited 191 elderly patients from 10 tertiary care settings in Thailand. MEASUREMENTS Participants provided data on their suicidal ideation and suicidal attempt using Module C of the Mini-International Neuropsychiatric Interview. Their attachment anxiety was assessed using the revised Experience of Close Relationship questionnaire (ECR-R-18), while their level of depression was investigated using the Geriatric Depression Scale. In addition, their perception of being supported was ascertained using the Multidimensional Scale of Perceived Social Support. We performed two mediation analyses and moderation analyses separately using the product of coefficients approach. First, we created a mediation model to examine the role of attachment anxiety and depression on suicidal ideation. Second, a moderated mediation model was created to explore the relationship of perceived social support as a moderator of depression. RESULTS We found that depression significantly mediated the association between attachment anxiety and suicidal ideation. The association between depression and suicidal ideation was moderated by the level of perceived social support. CONCLUSION Findings of this study may broaden our understanding of how suicidal ideation develops among the elderly and further stimulate future research exploring the interaction of positive and negative factors of suicidality among the elderly. Implications of the findings were also discussed.
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Lundin Å, Bergenheim A. Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists. BMC Psychiatry 2020; 20:597. [PMID: 33375943 PMCID: PMC7771061 DOI: 10.1186/s12888-020-03004-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. METHODS Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. RESULTS The analysis of the material revealed an overarching theme, Through barriers and taboos - the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. CONCLUSIONS The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.
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Affiliation(s)
- Åse Lundin
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
- Närhälsan Rehabilitation Centres, Region Västra Götaland, Gothenburg, Sweden.
| | - Anna Bergenheim
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Rehabilitation Centres, Region Västra Götaland, Gothenburg, Sweden
- Research, Development and Education Centre Fyrbodal, Region Västra Götaland, Vänersborg, Sweden
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Mobasseri K, Azami-Aghdash S, Khanijahani A, Khodayari-Zarnaq R. The Main Issues and Challenges Older Adults Face in the SARS-CoV-2 Pandemic: A Scoping Review of Literature. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:2295-2307. [PMID: 34178736 PMCID: PMC8215059 DOI: 10.18502/ijph.v49i12.4810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (SARS-CoV-2) severely affects those above the age of 60 yr and those with other conditions. This study aimed to review the available evidence on older adult's issues in facing the COVID-19 pandemic. Methods The framework is based on scoping review of literature published from Jan 10 to Jul 31, 2020. Medline, Scopus, Web of Science, and Google Scholar databases and other sources of information, to identify grey literature, were selected for data collection. Two researchers independently screened all studies and extracted data. All types of studies published about SARS-CoV-2 and related to older adults' issues were eligible. Results Overall, 210 documents were included in the final analysis. Letter to the editor was the most frequent article format (20.95%). Most of the papers were from the United States (38.09%) and published in Jun 2020 (29.52%). After content analysis, six following themes were extracted: Supporting and information sources, e-health services, access to essential supplies, Long Term Care Facilities (LTCFs), physical and mental consequences of self-isolation, neglect of older adults, ageism and age discrimination. Conclusion In the pandemic, there is an urgent need for interventional research and innovational implementations to address issues related to providing services for older adults. This can help older adults to maintain their physical and mental health, and reduce the spread of infection in nursing homes. Further studies focusing on the rights of the older adults are needed on all issues associated with COVID-19.
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Affiliation(s)
- Khorshid Mobasseri
- Department of Health Education and Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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41
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Cheung G, Rivera-Rodriguez C, Martinez-Ruiz A, Ma'u E, Ryan B, Burholt V, Bissielo A, Meehan B. Impact of COVID-19 on the health and psychosocial status of vulnerable older adults: study protocol for an observational study. BMC Public Health 2020; 20:1814. [PMID: 33256649 PMCID: PMC7702201 DOI: 10.1186/s12889-020-09900-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries around the world have adopted social distancing as one of the public health measures to reduce COVID-19 transmissions in the community. Such measures could have negative effects on the mental health of the population. The aims of this study are to (1) track the impact of COVID-19 on self-reported mood, self-rated health, other health and psychosocial indicators, and health services utilization of people who have an interRAI assessment during the first year of COVID-19; (2) compare these indicators with the same indicators in people who had an interRAI assessment in the year before COVID-19; and (3) report these indicators publicly as soon as data analysis is completed every 3 months. METHODS interRAI COVID-19 Study (iCoS) is an observational study on routinely collected national data using the interRAI Home Care and Contact Assessment, which are standardized geriatric assessment tools mandated for all people assessed for publicly funded home support services and aged residential care in New Zealand. Based on the 2018/19 figures, we estimated there are 36,000 interRAI assessments per annum. We will compare the four post-lockdown quarters (from 25th March 2020) with the respective pre-lockdown quarters. The primary outcomes are self-reported mood (feeling sad, depressed or hopeless: 0 = no, 1 = yes) and self-rated health (0 = excellent, 1 = good, 2 = fair, 3 = poor). We will also analyze sociodemographics, other secondary health and psychosocial indicators, and health services utilization. Descriptive statistics will be conducted for primary outcomes and other indicators for each of the eight quarters. We will compare the quarters using regression models adjusted for demographic characteristics using weights or additional variables. Key health and psychosocial indicators will be reported publicly as soon as data analysis is completed for each quarter in the 12-month post-lockdown period by using a data visualization tool. DISCUSSION This rapid translation of routinely collected national interRAI data will provide a means to monitor the health and psychosocial well-being of vulnerable older New Zealanders. Insights from this study can be shared with other countries that use interRAI and prepare health and social services for similar epidemics/pandemics in the future.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand. .,Brain Research New Zealand - Rangahau Roro Aotearoa, The University of Auckland, Auckland, New Zealand.
| | | | - Adrian Martinez-Ruiz
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.,Brain Research New Zealand - Rangahau Roro Aotearoa, The University of Auckland, Auckland, New Zealand.,Department of Demographic Epidemiology and Social Determinants, National Institute of Geriatrics of Mexico, Mexico City, Mexico
| | - Etuini Ma'u
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Brigid Ryan
- Brain Research New Zealand - Rangahau Roro Aotearoa, The University of Auckland, Auckland, New Zealand.,Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Vanessa Burholt
- School of Nursing / School of Population Health, The University of Auckland, Auckland, UK.,Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Wales, New Zealand
| | - Ange Bissielo
- interRAI Services, Technical Advisory Services (TAS) Limited, Wellington, UK
| | - Brigette Meehan
- interRAI Services, Technical Advisory Services (TAS) Limited, Wellington, UK
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Ostuzzi G, Gastaldon C, Barbato A, D'Avanzo B, Tettamanti M, Monti I, Aguglia A, Aguglia E, Alessi MC, Amore M, Bartoli F, Biondi M, Bortolaso P, Callegari C, Carrà G, Caruso R, Cavallotti S, Crocamo C, D'Agostino A, De Fazio P, Di Natale C, Giusti L, Grassi L, Martinotti G, Nosé M, Papola D, Purgato M, Rodolico A, Roncone R, Tarsitani L, Turrini G, Zanini E, Amaddeo F, Ruggeri M, Barbui C. Tolerability and efficacy of vortioxetine versus SSRIs in elderly with major depression. Study protocol of the VESPA study: a pragmatic, multicentre, open-label, parallel-group, superiority, randomized trial. Trials 2020; 21:695. [PMID: 32746941 PMCID: PMC7397635 DOI: 10.1186/s13063-020-04460-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction Depression is a highly prevalent condition in the elderly, with a vast impact on quality of life, life expectancy, and medical outcomes. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed agents in this condition and, although generally safe, tolerability issues cannot be overlooked. Vortioxetine is an antidepressant with a novel mechanism of action. Based on studies to date, it may have a promising tolerability profile in the elderly, as it does not adversely affect psychomotor or cognitive performance and does not alter cardiovascular and endocrine parameters. The present study aims to assess the tolerability profile of vortioxetine in comparison with the SSRIs considered as a single group in elderly participants with depression. The rate of participants withdrawing from treatment due to adverse events after 6 months of follow up will be the primary outcome. Methods and analysis This is a pragmatic, multicentre, open-label, parallel-group, superiority, randomized trial funded by the Italian Medicines Agency (AIFA - Agenzia Italiana del Farmaco). Thirteen Italian Community Psychiatric Services will consecutively enrol elderly participants suffering from an episode of major depression over a period of 12 months. Participants will be assessed at baseline and after 1, 3 and 6 months of follow up. At each time point, the following validated rating scales will be administered: Montgomery–Åsberg Depression Rating Scale (MADRS), Antidepressant Side-Effect Checklist (ASEC), EuroQual 5 Dimensions (EQ-5D), Short Blessed Test (SBT), and Charlson Age-Comorbidity Index (CACI). Outcome assessors and the statistician will be masked to treatment allocation. A total of 358 participants (179 in each group) will be enrolled. Ethics and dissemination This study will fully adhere to the ICH E6 Guideline for Good Clinical Practice. Participants’ data will be managed and safeguarded according to the European Data Protection Regulation 2016/679. An external Ethical Advisory Board will help guarantee high ethical standards. Trial registration Clinicaltrials.gov: NCT03779789, Registered on 19 December 2018. Submitted on 19 December. EudraCT number: 2018–001444-66. Trial status Protocol version 1.5; 09/06/2018. Recruitment started In February 2019 and it is ongoing. It is expected to end approximately on 30 September 2021.
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Affiliation(s)
- Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
| | - Angelo Barbato
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mauro Tettamanti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Igor Monti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Genoa, Italy.,Section of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, U.O.C. Clinica Psichiatrica, A.O.U. Policlinico-Vittorio Emanuele, Presidio "G. Rodolico", Catania, Italy
| | - Maria Chiara Alessi
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche Università "G. D'Annunzio Chieti-Pescara", Chieti, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Genoa, Italy.,Section of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Bartoli
- Dipartimento di Medicina e Chirurgia, Università di Milano Bicocca, Milan, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Paola Bortolaso
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Giuseppe Carrà
- Dipartimento di Medicina e Chirurgia, Università di Milano Bicocca, Milan, Italy.,Division of Psychiatry, University College London, London, UK
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Cristina Crocamo
- Dipartimento di Medicina e Chirurgia, Università di Milano Bicocca, Milan, Italy
| | - Armando D'Agostino
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Pasquale De Fazio
- Azienda Ospedaliera Universitaria Mater Domini, Università Magna Grecia, Catanzaro, Italy
| | - Chiara Di Natale
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche Università "G. D'Annunzio Chieti-Pescara", Chieti, Italy
| | - Laura Giusti
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Martinotti
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche Università "G. D'Annunzio Chieti-Pescara", Chieti, Italy
| | - Michela Nosé
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Davide Papola
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, U.O.C. Clinica Psichiatrica, A.O.U. Policlinico-Vittorio Emanuele, Presidio "G. Rodolico", Catania, Italy
| | - Rita Roncone
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Turrini
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Elisa Zanini
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Borentain S, Nash AI, Dayal R, DiBernardo A. Patient-reported outcomes in major depressive disorder with suicidal ideation: a real-world data analysis using PatientsLikeMe platform. BMC Psychiatry 2020; 20:384. [PMID: 32703173 PMCID: PMC7376651 DOI: 10.1186/s12888-020-02758-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current analysis utilized data collected via an online patient community platform, PatientsLikeMe (PLM) to compare patient-reported experiences in patients with major depressive disorder (MDD) with suicidal ideation (MDSI) to those with MDD but without suicidal ideation. METHODS PLM members who joined PLM between May-2007 and February-2018 and reported a diagnosis of MDD were included. The MDSI cohort included patients with MDD who reported at least one suicide-related symptom at a severity greater than "none". Demographics, comorbidities, symptoms, and side-effects were compared between MDSI and MDD cohorts. Factors correlated with suicidal ideation (SI) were determined by a random forest procedure. RESULTS Patients in the MDSI cohort (n = 266) were younger (median age, 36 vs 44 years) with an earlier disease onset (before 30 years, 83% vs 71%), and a longer diagnosis latency (median, 4 vs 2 years) vs patients in the MDD cohort (n = 11,963). Majority of patients were women in both cohorts (73% vs 83%). Median number of psychiatric comorbidities was higher in the MDSI cohort (4 vs 3). Unprompted symptoms (e.g., loneliness, feeling of hopelessness, social anxiety, impulsivity, and self-hating thoughts) were more frequent in the MDSI cohort. Hopelessness, loneliness, anhedonia, social anxiety, and younger age were highly correlated with suicidal ideation. CONCLUSIONS This analysis utilized patient-reported data to better understand symptoms, experiences, and characteristics of patients with MDSI compared to patients with MDD. The results identified various risk factors correlated with suicidal ideation that may help guide clinical judgement for patients with MDD who may not voluntarily report suicidal ideation.
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Affiliation(s)
| | - Abigail I. Nash
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Rachna Dayal
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | - Allitia DiBernardo
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
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What are the sociodemographic and gender determinants of non-fatal self-harm in older adult users and non-users of antidepressants? A national population-based study. BMC Public Health 2020; 20:764. [PMID: 32539817 PMCID: PMC7296708 DOI: 10.1186/s12889-020-08892-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-life self-harm (SH) is often linked to depression. However, very few studies have explored the role of other factors and their interaction with depression in the occurrence of late-life SH. The objective of this research was to examine sociodemographic and gender factors associated with non-fatal SH, in older adults with and without antidepressant therapy. METHODS We used national longitudinal register data from a total cohort of all Swedish residents aged ≥75 years between 2006 and 2014 (N = 1,413,806). Using personal identity numbers, we linked individuals' data from numerous national registers. We identified all those with at least one episode of non-fatal self-harm (regardless of level of intent to die) and matched 50 controls to each case. A nested case-control design was used to investigate sociodemographic factors associated with non-fatal SH in the total cohort and among antidepressant users and non-users. Risk factors were analysed in adjusted conditional logistic regression models for the entire cohort and by gender. RESULTS In all, 2242 individuals had at least one episode of a non-fatal SH (980 men and 1262 women). Being unmarried was a risk factor for non-fatal SH in men but not in women. Among users of antidepressants, higher non-fatal SH risk was observed in those born outside the Nordic countries (IRR: 1.44; 95% CI: 1.11-1.86), whereas in AD non-users increased risk was seen in those from Nordic countries other than Sweden (IRR: 1.58; 95% CI: 1.08-2.29). Antidepressant users with higher education had an increased risk of non-fatal SH (IRR: 1.34; 95% CI: 1.12-1.61), in both men and women. CONCLUSIONS Foreign country of birth was associated with increased risk for non-fatal SH in older adults with and without AD therapies. Being married was a protective factor for non-fatal SH in men. The complex association between sociodemographic factors and use of antidepressants in the occurrence of self-harm in older men and women indicates the need for multifaceted tailored preventive strategies including healthcare and social services alike.
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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Rezapur-Shahkolai F, Khezeli M, Hazavehei SMM, Ariapooran S, Soltanian AR, Ahmadi A. The effects of suicidal ideation and constructs of theory of planned behavior on suicidal intention in women: a structural equation modeling approach. BMC Psychiatry 2020; 20:217. [PMID: 32393299 PMCID: PMC7216686 DOI: 10.1186/s12888-020-02625-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Theory of Planned Behavior (TPB) is proposed to predict behavioral intention. We conducted this study aimed to investigate the effects of Suicidal Ideation (SI) and constructs of TPB on suicidal intention. METHODS This cross-sectional study was conducted with 923 married women selected by multi-stage sampling method from Gilan-e Gharb County, the west part of Iran, in 2018. Data gathering tools were a questionnaire on demographic characteristics, the Beck Scale for Suicidal Ideation, and a four-part questionnaire based on constructs of TPB, including Attitude, Subjective Norms, Perceived Behavioral Control (PBC), and Intention. Data were analyzed by SPSS 19 and AMOS using Structural Equation Modeling (SEM). RESULTS Out of 923 participants, 345 women (37.4%) had some degree of suicidal ideation. The mean score of suicidal ideation in all of participants was 5.98 ± 7.79, while in the 345 individuals with suicidal ideation was 15.53 ± 3.65. Suicidal ideation had the strongest positive total effect on suicide intent, while PBC and attitude had the negative effect on suicide intent. CONCLUSIONS Since suicidal ideation had the strongest direct effect on suicidal intent, it is suggested that this variable be used for risk assessment in all suicide prevention programs and counseling measures be implemented to reduce suicidal thoughts. Also, undesirable attitudes toward suicide and perceived behavioral control on suicide intention can be considered and emphasized in planning future interventions.
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Affiliation(s)
- Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Khezeli
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | | | | | - Ali Reza Soltanian
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Non-communicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Ahmadi
- Department of Anesthesiology, Imam Reza Hospital Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Cheng X, Bu H, Duan W, He A, Zhang Y. Measuring character strengths as possible protective factors against suicidal ideation in older Chinese adults: a cross-sectional study. BMC Public Health 2020; 20:439. [PMID: 32245407 PMCID: PMC7118809 DOI: 10.1186/s12889-020-8457-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Suicide is a global issue among the elderly. The number of older people committing suicide is proliferating, and the elderly suicide rate is the highest among all age groups in China. A better understanding of the possible protective factors against suicidal ideation is necessary to facilitate prevention and intervention efforts. The objectives of the present study are threefold. First, this study aims to examine the psychometric properties of the three-dimensional inventory of character strengths (TICS) with a sample of older adults. Second, this study intends to investigate correlations among suicide ideation, wellbeing, and character strengths. Third, the study seeks to explore the possible protective roles of the three character strengths and wellbeing in explaining suicidal ideation among older adults. METHODS A cross-sectional study comprising 308 older adults aged at least 50 years old from nursing homes was conducted. Four questionnaires, namely, the TICS, the Geriatric Suicide Ideation Scale-10 items, the Brief Inventory of Thriving, and the Satisfaction with Life Scale, were used. Exploratory structural equation modeling, intraclass correlation coefficients, partial correlations, and sets of hierarchical regressions were adopted to estimate and report the results. RESULTS TICS could be used to assess the character strengths (i.e., caring, inquisitiveness, and self-control) among older adults with an acceptable goodness-of-fit (chi square = 157.30, df = 63, p < 0.001, CFI = 0.94, TLI = 0.90, RMSEA = 0.07, 90% CI = [0.06, 0.08]). Wellbeing and character strengths exhibited a negative association with suicidal ideation among older adults. Moreover, character strengths showed an independently cross-sectional relationship with suicidal ideation, explaining 65.1% of the variance of suicidal ideation after controlling for the wellbeing and demographics. CONCLUSION This study indicated that character strengths were associated with low levels of suicidal ideation. Therefore, the protective factors against suicidal ideation among older adults should be given additional attention.
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Affiliation(s)
- Xinfeng Cheng
- Economics and Management Department, Xi'an Technological University, Xi'an, China.,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - He Bu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Wenjie Duan
- Social and Public Administration School, East China University of Science and Technology, Shanghai, China.
| | - Along He
- Department of Sociology, Wuhan University, Wuhan, China
| | - Yaping Zhang
- Goizueta Business School, Emory University, Atlanta, Georgia
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Schmutte TJ, Wilkinson ST. Suicide in Older Adults With and Without Known Mental Illness: Results From the National Violent Death Reporting System, 2003-2016. Am J Prev Med 2020; 58:584-590. [PMID: 32001049 PMCID: PMC7089842 DOI: 10.1016/j.amepre.2019.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Suicide risk increases with age, and evidence exists for the underdiagnosis and undertreatment of suicide risk in older adults. Recent data suggest that many U.S. adults who die from suicide do not have a known mental health condition. This study compares the characteristics and precipitating circumstances of geriatric suicide decedents with and without known mental illnesses. METHODS This study was a retrospective analysis of suicide deaths for adults aged ≥65 years from the National Violent Death Reporting System, 2003-2016 (n=26,884). ORs compared sociodemographic and clinical characteristics, cause of death, and precipitating circumstances based on coroner/medical examiner and law enforcement reports. Data were collected and analyzed in 2019. RESULTS Most older male (69.1%) and female (50.2%) suicide decedents did not have a known mental illness. A physical health problem was the most prevalent precipitating circumstance but was more common among older adults without known mental illness. Past suicide attempt, disclosure of suicidal intent, depressed mood, and substance use were more common among those with a known mental illness. More than three fourths of suicide decedents did not disclose their suicidal intent. Most suicide deaths involved firearms, which were disproportionately used by decedents without known mental illness (81.6% of male and 44.6% of female decedents) compared with those with known mental illness (70.5% of male and 30.0% of female decedents). CONCLUSIONS Most older adults who die from suicide do not have a known mental health condition. The rapidly growing U.S. geriatric population calls for more effective methods to identify and treat at-risk older adults, particularly those who are male.
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Affiliation(s)
- Timothy J Schmutte
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Hofstra E, van Nieuwenhuizen C, Bakker M, Özgül D, Elfeddali I, de Jong SJ, van der Feltz-Cornelis CM. Effectiveness of suicide prevention interventions: A systematic review and meta-analysis. Gen Hosp Psychiatry 2020; 63:127-140. [PMID: 31078311 DOI: 10.1016/j.genhosppsych.2019.04.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/05/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study provides an estimate of the effect size of suicide prevention interventions and evaluates the possible synergistic effects of multilevel interventions. METHOD A systematic review and meta-analysis were conducted of controlled studies evaluating suicide prevention interventions versus control published between 2011 and 2017 in PubMed, PsycINFO, and Cochrane databases. Data extraction and risk of bias assessment according to ROBINS criteria were performed by independent assessors. Cohen's delta was calculated by a random meta-analysis on completed and attempted suicides as outcomes. Meta-regression explored a possible synergistic effect in multilevel interventions. PROSPERO ID number: CRD42018094373. RESULTS The search yielded 16 controlled studies with a total of 252,932 participants. The meta-analysis was performed in 15 studies with 29,071 participants. A significant effect was found for suicide prevention interventions on completed suicides (d = -0.535, 95% CI -0.898; -0.171, p = .004) and on suicide attempts (d = -0.449, 95% CI -0.618; -0.280, p < .001). Regarding the synergistic effect of multilevel interventions, meta-regression showed a significantly higher effect related to the number of levels of the intervention (p = .032). CONCLUSIONS Suicide prevention interventions are effective in preventing completed and attempted suicides and should be widely implemented. Further research should focus on multilevel interventions due to their greater effects and synergistic potential. Further research is also needed into risk appraisal for completed versus attempted suicide, as the preferred intervention strategy differs with regard to both outcomes.
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Affiliation(s)
- Emma Hofstra
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands; Tranzo - Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, Netherlands.
| | - Chijs van Nieuwenhuizen
- Tranzo - Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, Netherlands; Institute for Mental Health Care, GGzE, Eindhoven, Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| | - Dilana Özgül
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands
| | - Iman Elfeddali
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands; Tranzo - Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Sjakko J de Jong
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands; Tranzo - Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Christina M van der Feltz-Cornelis
- Tranzo - Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, Netherlands; The Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK
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Okolie C, Wood S, Hawton K, Kandalama U, Glendenning AC, Dennis M, Price SF, Lloyd K, John A. Means restriction for the prevention of suicide by jumping. Cochrane Database Syst Rev 2020; 2:CD013543. [PMID: 32092795 PMCID: PMC7039710 DOI: 10.1002/14651858.cd013543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Jumping from a height is an uncommon but lethal means of suicide. Restricting access to means is an important universal or population-based approach to suicide prevention with clear evidence of its effectiveness. However, the evidence with respect to means restriction for the prevention of suicide by jumping is not well established. OBJECTIVES To evaluate the effectiveness of interventions to restrict the availability of, or access to, means of suicide by jumping. These include the use of physical barriers, fencing or safety nets at frequently-used jumping sites, or restriction of access to these sites, such as by way of road closures. SEARCH METHODS We searched the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science to May 2019. We conducted additional searches of the international trial registries including the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, to identify relevant unpublished and ongoing studies. We searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors and subject experts for information on unpublished or ongoing studies. We applied no restrictions on date, language or publication status to the searches. Two review authors independently assessed all citations from the searches and identified relevant titles and abstracts. Our main outcomes of interest were suicide, attempted suicide or self-harm, and cost-effectiveness of interventions. SELECTION CRITERIA Eligible studies were randomised or quasi-randomised controlled trials, controlled intervention studies without randomisation, before-and-after studies, or studies using interrupted time series designs, which evaluated interventions to restrict the availability of, or access to, means of suicide by jumping. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion and three review authors extracted study data. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary. We summarised the quality of the evidence included in this review using the GRADE approach. MAIN RESULTS We included 14 studies in this review. Thirteen were before-and-after studies and one was a cost-effectiveness analysis. Three studies each took place in Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies (10/14) assessed jumping means restriction interventions delivered in isolation, half of which were at bridges. Due to the observational nature of included studies, none compared comparator interventions or control conditions. During the pre- and postintervention period among the 13 before-and-after studies, a total of 742.3 suicides (5.5 suicides per year) occurred during the pre-intervention period (134.5 study years), while 70.6 suicides (0.8 suicides per year) occurred during the postintervention period (92.4 study years) - a 91% reduction in suicides. A meta-analysis of all studies assessing jumping means restriction interventions (delivered in isolation or in combination with other interventions) showed a directionality of effect in favour of the interventions, as evidenced by a reduction in the number of suicides at intervention sites (12 studies; incidence rate ratio (IRR) = 0.09, 95% confidence interval (CI) 0.03 to 0.27; P < 0.001; I2 = 88.40%). Similar findings were demonstrated for studies assessing jumping means restriction interventions delivered in isolation (9 studies; IRR = 0.05, 95% CI 0.01 to 0.16; P < 0.001; I2 = 73.67%), studies assessing jumping means restriction interventions delivered in combination with other interventions (3 studies; IRR = 0.54, 95% CI 0.31 to 0.93; P = 0.03; I2 = 40.8%), studies assessing the effectiveness of physical barriers (7 studies; IRR = 0.07, 95% CI 0.02 to 0.24; P < 0.001; I2 = 84.07%), and studies assessing the effectiveness of safety nets (2 studies; IRR = 0.09, 95% CI 0.01 to 1.30; P = 0.07; I2 = 29.3%). Data on suicide attempts were limited and none of the studies used self-harm as an outcome. There was considerable heterogeneity between studies for the primary outcome (suicide) in the majority of the analyses except those relating to jumping means restriction delivered in combination with other interventions, and safety nets. Nevertheless, every study included in the forest plots showed the same directional effects in favour of jumping means restriction. Due to methodological limitations of the included studies, we rated the quality of the evidence from these studies as low. A cost-effectiveness analysis suggested that the construction of a physical barrier on a bridge would be a highly cost-effective project in the long term as a result of overall reduced suicide mortality. AUTHORS' CONCLUSIONS The findings from this review suggest that jumping means restriction interventions are capable of reducing the frequency of suicides by jumping. However, due to methodological limitations of included studies, this finding is based on low-quality evidence. Therefore, further well-designed high-quality studies are required to further evaluate the effectiveness of these interventions, as well as other measures at jumping sites. In addition, further research is required to investigate the potential for suicide method substitution and displacement effects in populations exposed to interventions to prevent suicide by jumping.
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Affiliation(s)
- Chukwudi Okolie
- Swansea University Medical SchoolSwanseaUKSA2 8PP
- Public Health WalesSwanseaUK
| | | | - Keith Hawton
- Warneford HospitalCentre for Suicide Research, University Department of PsychiatryOxfordUKOX3 7JX
| | | | | | | | - Sian F Price
- Public Health WalesPublic Health Wales ObservatoryPO Box 108, Building 1, St David?s ParkCarmarthenWalesUKSA31 3WY
| | - Keith Lloyd
- Swansea University Medical SchoolSwanseaUKSA2 8PP
| | - Ann John
- Swansea University Medical SchoolSwanseaUKSA2 8PP
- Public Health WalesSwanseaUK
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